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Massive global rise in peripheral artery disease

New research suggests 200m sufferers worldwide mainly in low to middle income countries

Mark Gould

Thursday, 01 August 2013

New research shows the incidence of peripheral heart disease (PAD) has gone up by almost 25% in the ten years from about 164 million in 2000 to 202 million in 2010, according to the first robust global estimates.

The estimates published in The Lancet today suggest that the PAD burden is increasing in every region, and that the findings are a 'call to action' given that people with PAD have a roughly three fold increased risk of heart attack and stroke according to lead author Professor Gerry Fowkes from the University of Edinburgh.

He says that the majority (140.8 million; 70%) of people with PAD are now living in low-income or middle-income countries (LMIC), mainly in southeast Asia (54.8 million) and western Pacific regions (45.9 million).

“Despite its alarming prevalence and cardiovascular risk implications little attention has been paid to this disease”, he said.

Fowkes and colleagues identified over 100 studies that looked at the incidence or prevalence of PAD. Analysis and modelling of data from 34 community-based studies published since 1997, that identified PAD using the ankle brachial index (ABI; a simple test that measures the ratio of blood pressure at the ankle to that in the arm), were used to develop age-specific and sex-specific prevalence rates in high-income countries (HIC) and LMIC, and to establish the main risk factors for PAD.

Longer life expectancy, as well as changing lifestyles, appears to be driving this dramatic rise in PAD rates, leading to a greater than 35% increase in cases older than 80 years, with PAD now affecting 1 in 10 people aged 70 years and 1 in 6 people older than 80 years worldwide.

The researchers identified higher rates of PAD among men in HIC than men in LMIC, whilst PAD may be more prevalent in women than in men in LMIC, especially at younger ages.

The analysis also confirmed that many of the key risk factors for PAD such as smoking, diabetes, hypertension, and high cholesterol are the same as those for other major cardiovascular disorders, and can be prevented and treated.

According to Professor Fowkes, “PAD has become a global problem in the 21st century and can no longer be regarded as a disease that affects mostly HIC. The dramatic growth in PAD is already a major public health challenge due to loss of mobility, diminished quality of life, and the significantly increased risk of heart attack and stroke. As the world’s population ages, PAD will become substantially more common, and there is an urgent need to assess treatment and prevention strategies in both HIC and LMICs.”

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